Look above the IRP: predicting abnormal confirmatory testing in patients with esophagogastric junction outflow obstruction

Alexandra Strauss Starling; Shivani U Thanawala; Claire A Beveridge; Gary W Falk; Kristle L Lynch

doi:10.1177/17562848241306128

Look above the IRP: predicting abnormal confirmatory testing in patients with esophagogastric junction outflow obstruction

Therap Adv Gastroenterol. 2024 Dec 23:17:17562848241306128. doi: 10.1177/17562848241306128. eCollection 2024.

Authors

Alexandra Strauss Starling¹, Shivani U Thanawala¹, Claire A Beveridge², Gary W Falk¹, Kristle L Lynch³

Affiliations

¹ Division of Gastroenterology & Hepatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
² Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
³ Division of Gastroenterology & Hepatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Perelman Center for Advanced Medicine, 750 South 3400 Civic Center Blvd, Philadelphia, PA 19104, USA.

Abstract

Background: Esophagogastric junction outflow obstruction (EGJOO) is a manometric diagnosis based on Chicago Classification version 4.0 (CC4.0) that requires confirmatory testing for clinical relevancy. However, it is still unclear which patients will respond to therapy.

Objectives: To evaluate manometric and clinical predictors of abnormal confirmatory testing for patients with EGJOO.

Design: This was a prospective observational study of patients with manometric EGJOO and chest pain or dysphagia who underwent confirmatory testing.

Methods: Patients with EGJOO on manometry were enrolled and underwent timed barium esophagram or endoFLIP. A subset of patients was given validated surveys, including Eckardt scores (ES) and PROMIS-10.

Results: For patients with a CC4.0 EGJOO diagnosis, abnormal peristalsis (OR = 7.0, 95% CI = 1.01-44.6, p = 0.04) and increases in ES (OR = 2.34 95% CI = 1.13-4.86, p = 0.02) were associated with positive confirmatory testing.

Conclusion: Patients with potentially actionable EGJOO were more likely to have an abnormal peristaltic subtype of EGJOO or higher ES.

Keywords: dysphagia; esophageal motility disorder; esophagogastrojunction.

Plain language summary

Predicting abnormal confirmatory testing in patients with esophagogastric junction outflow obstruction (EGJOO) Esophagogastric junction outflow obstruction (EGJOO) is a diagnosis based on esophageal manometry, which is a test that measures the muscles of the esophagus. EGJOO is when the lower esophageal sphincter is tight and does not relax well. This diagnosis requires confirmatory testing for clinical relevancy, as it can be seen commonly on testing without always having relevancy to a patient’s presentation. We evaluated predictors of abnormal confirmatory testing for patients with EGJOO. Patients with EGJOO on manometry were enrolled and underwent two types of confirmatory testing and some patients were given surveys about symptoms of difficulty swallowing and quality of life. Patients with EGJOO diagnosis were more likely to have abnormal confirmatory testing with higher scores of symptom severity or if they had other types of abnormal muscle changes in the esophagus.